RMA-Formular – ≡ Plasmadiam® – Swiss Vacuum Solutions

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Erklärung zur Kontamination - Formular HS2

Lesen und befolgen Sie das Verfahren HS2, bevor Sie diese Erklärung ausfüllen. Diese Erklärung darf nur von autorisiertem und qualifiziertem Personal ausgefüllt und unterzeichnet werden. Wenn Sie Hilfe beim Ausfüllen dieses Formulars benötigen, wenden Sie sich bitte an den Vertrieb oder die Kundenbetreuung in Ihrer Nähe.

Equipment

Manufacturer's Product Name

Manufacturer's Serial Number

If applicable

Tool Identification Number

Tool Manufacturer/OEM

Tool Model

Process

Installed Date

De-installed Date

Part Number of Replacement Equipment

Serial Number of Replacement Equipment

Condition of equipment
We will not accept delivery of any equipment that is contaminated with radioactive substances, biological/ infectious agents, mercury, PCB’s, dioxins or sodium azide. Was your equipment infected by one of these substance ?

Question0

YES NO

PLEASE STOP FILLING THE FORM AND CONTACT OUR TEAM AT CONTACT@PLASMADIAM

Condition of equipment
What substance your equipment has been infected by ?

Substance

Chemical Symbol

Precautions required (for example, use protective gloves, etc.)

Action required after a spill, leak or exposure

More substance ?

Question 2

YES NO

Substance

Chemical Symbol

Precautions required (for example use protective gloves, etc.)

Action required after a spill, leak or exposure

More substance ?

Question 3

YES NO

Substance

Chemical Symbol

Precautions required (for example use protective gloves, etc.)

Action required after a spill, leak or exposure

Return information

Reason for return and symptoms of malfunction

For how many hours has the product run ?

Declaration

Name

Job Title

Organisation

Address

Telephone number

Date of equipment delivery

Signature

I have made reasonable enquiry and I have supplied accurate information in this Declaration.
I have not withheld any information, and I have followed the Procedure HS1.

Signature

Date

Komponenten

Komponenten

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Erklärung zur Kontamination - Formular HS2

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